北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (1): 165-168.

• 论著 • 上一篇    下一篇

肝实质段覆膜支架精确覆盖技术在经颈静脉肝内门体分流术中的应用

王昌明,李选△,傅军,栾景源,李天润,赵军,董国祥   

  1. (北京大学第三医院介入血管外科,北京100191)
  • 出版日期:2014-02-18 发布日期:2014-02-18

Technological modification of transjugular intrahepatic portosystemic shunt: the precise covering of parenchymal shunt with stent-graft

WANG Chang-ming, LI Xuan△, FU Jun, LUAN Jing-yuan, LI Tian-run, ZHAO Jun, DONG Guo-xiang   

  1. (Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China)
  • Online:2014-02-18 Published:2014-02-18

摘要: 目的:以裸支架加覆膜支架形式建立肝实质内门腔分流道,评价肝实质段覆膜支架精确覆盖技术的可行性及疗效。方法:17例肝硬化 、门脉高压症所致上消化道出血患者,行经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)。改良支架放 置技术,以裸金属支架连接门静脉与下腔静脉,定位分流道肝实质段,以覆膜支架精确覆盖,建立门腔分流体系。测量比较分流前后门体静脉 压力梯度值(portosystemic gradient,PSG)的变化,评价技术可行性、安全性及临床治疗效果。结果:17例手术全部获得成功。分流前后 PSG差异有统计学意义[(28.2±7.6) mmHg vs. (12.1±3.5) mmHg,1 mmHg=0.133 kPa, P<0.001]。术后近期死亡1例,其他所有病例均 获随访,中位随访时间181 d (32~563 d)。随访过程中3例死亡,原因分别为肝性脑病、肝功能衰竭及败血症,其余13例存活。2例发生肝性 脑病经药物治疗缓解。支架通畅率100%,无复发出血。术前及随访结束时Child-Pugh评分分别为(7.8±2.0)分和(7.5±1.7)分,差异无统 计学意义(P=0.584)。结论:使用组合支架(裸支架+覆膜支架形式)实现肝实质分流道准确定位,覆膜支架精确放置在操作上相对简单, PSG降低幅度在一定程度上可调控。经临床初步应用及短期随访,支架通畅率高,肝性脑病发生率及再出血率较低,综合疗效满意。

关键词: 门体分流术, 经颈静脉肝内, 高血压, 门静脉, 食管和胃静脉曲张, 放射学, 介入性, 支架

Abstract: Objective:To introduce the technological modification of stents placement with combined naked self-expanding stent and stent-graft for the construction of portosystemic shunt during transjugular intrahepatic portosystemic shunt (TIPS). Methods: In the study, 17 patients who suffered from upper digestive tract hemorrhage due to portal hypertension post liver cirrhosis underwent modified TIPS. The shunts were constructed with stepwise placement of naked self-expanding stent and a stent-graft other than stent-graft only for the purpose of precisely covering the parenchymal segment of the shunt and the active control of portosystemic gradient (PSG). The feasibility, safety, and clinical application results of the new technique were analyzed. Results: Technically, the success rate of operation was 100%. The mean PSG before and after TIPS was (28.2±7.6) mmHg, (12.1±3.5) mmHg, respectively (1 mmHg=0.133 kPa, P<0.001). One patient died 6 days after operation. The median follow-up period was 181 days (ranging from 32 days to 563 days) for all the other 16 cases, during which period 3 patients died because of encephalopathy, liver failure and septicemia, respectively, and 2 cases of encephalopathy occurred and were relieved with medical treatment. The shunts patency rate was 100% and no chance of digestive re-bleeding occurred. The mean Child-Pugh score before TIPS and at the end of the follow-up was (7.8±2.0) points and (7.5±1.7) points, respectively (P=0.584). Conclusion: The technological modification of TIPS with combined naked self-expanding stent and stent-graft for the precise covering of the parenchymal segment of the shunts was relatively simple to apply, and was helpful for the adjustment of PSG. The preliminary clinical application indicated that it had satisfying results in the matter of shunts patency, incidence of encephalopathy, and the relapse of digestive bleeding during the short-term follow up.

Key words: Portosystemic shunt, transjugular intrahepatic, Hypertension, portal, Esophageal and gastric varices, Radiology, interventional, Stents

[1] 杨文博,余磊,张维宇,徐涛,王强. 带线输尿管支架自排技术在肾移植受者中的效果及安全性[J]. 北京大学学报(医学版), 2024, 56(4): 656-660.
[2] 陈楚云,孙蓬飞,赵静,贾佳,范芳芳,王春燕,李建平,姜一梦,霍勇,张岩. 北京社区人群促红细胞生成素相关因素及其与10年心血管疾病风险的关系[J]. 北京大学学报(医学版), 2023, 55(6): 1068-1073.
[3] 赖金惠,王起,姬家祥,王明瑞,唐鑫伟,许克新,徐涛,胡浩. 新型冠状病毒肺炎疫情期间延迟拔除输尿管支架对泌尿系结石术后患者生活质量和心理状态的影响[J]. 北京大学学报(医学版), 2023, 55(5): 857-864.
[4] 田慈,白颐,马青变,葛洪霞. 7例肝门静脉积气的临床特征分析[J]. 北京大学学报(医学版), 2023, 55(4): 743-747.
[5] 韩金涛,张宇翔,贾子昌,姜除寒,刘恋,栾景源,梁飞,赵彦清. Neuroform Atlas支架辅助弹簧圈栓塞未破裂性颅内宽颈动脉瘤[J]. 北京大学学报(医学版), 2023, 55(1): 139-143.
[6] 李雨柯,王梅,唐琳,刘玉华,陈晓颖. 不同pH值对脱细胞小肠黏膜下层海绵支架螯合锶离子的影响[J]. 北京大学学报(医学版), 2023, 55(1): 44-51.
[7] 梁喆,范芳芳,张岩,秦献辉,李建平,霍勇. 中国高血压人群中H型高血压的比率和特征及与美国人群的比较[J]. 北京大学学报(医学版), 2022, 54(5): 1028-1037.
[8] 马麟,吴静依,李双成,李鹏飞,张路霞. 抗高血压药物对二氧化氮长期暴露与慢性肾脏病关联的修饰效应[J]. 北京大学学报(医学版), 2022, 54(5): 1047-1055.
[9] 张春龙,王明瑞,王起,许克新,徐涛,胡浩. 覆膜金属输尿管支架维持性治疗输尿管镜碎石术后难治性输尿管狭窄的远期疗效评价[J]. 北京大学学报(医学版), 2022, 54(4): 674-679.
[10] 皇甫宇超,杜依青,于路平,徐涛. 原发性醛固酮增多症术后高血压未治愈的危险因素[J]. 北京大学学报(医学版), 2022, 54(4): 686-691.
[11] 邓艺,张一,李博文,王梅,唐琳,刘玉华. 不同交联剂处理对脱细胞小肠黏膜下层多孔支架的影响[J]. 北京大学学报(医学版), 2022, 54(3): 557-564.
[12] 李志胜,钱浩楠,范田园. 熔融沉积成型3D打印卡托普利与氢氯噻嗪复方片剂的制备与体外评价[J]. 北京大学学报(医学版), 2022, 54(3): 572-577.
[13] 朱正达,高岩,何汶秀,方鑫,刘洋,魏攀,闫志敏,华红. 红色诺卡氏菌细胞壁骨架治疗糜烂型口腔扁平苔藓的疗效及安全性[J]. 北京大学学报(医学版), 2021, 53(5): 964-969.
[14] 庄金满,李天润,李选,栾景源,王昌明,冯琦琛,韩金涛. Rotarex 旋切导管在下肢动脉硬化闭塞症支架内再狭窄中的应用[J]. 北京大学学报(医学版), 2021, 53(4): 740-743.
[15] 董文敏,王明瑞,胡浩,王起,许克新,徐涛. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报(医学版), 2020, 52(4): 637-641.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!